Healthcare Provider Details

I. General information

NPI: 1235060658
Provider Name (Legal Business Name): MISTY MARIE WOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2958 STOGNER DR
LANCASTER SC
29720-9372
US

IV. Provider business mailing address

2958 STOGNER DR
LANCASTER SC
29720-9372
US

V. Phone/Fax

Practice location:
  • Phone: 803-283-7654
  • Fax: 803-283-7654
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SI0800X
TaxonomyInformatics Clinical Nurse Specialist
License Number301536
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: